70,000 DEAD? CAN WE PLEASE TALK ABOUT THE ELEPHANT IN THE ROOM.

CREATE SOLUTIONS NOT JUST AWARENESS. A MANIFESTO. A PLEA FOR HONESTY.

As the data rolls in from 2016 it appears the death toll from overdose could actually exceed 70,000.

Let's talk about the elephant in the room. Let's get real...

Let's have a debate. Let's have a difficult conversation. Are we allowed to disagree? Is there room for dissenting opinions? I could be wrong. Maybe our current approach to the addiction crisis is the best approach. I don't think it is, but hey, I'm open-minded. Or do I get kicked out of the club for not toeing the company line?

One thing for sure: 70,000 dead is disgusting. Sickening that we accept this and do not respond in radical ways.

For me, this has become a moral issue. At this point we have a moral and ethical responsibility to address this issue at its core. We hold tight to an antiquated approach that has never been shown to be effective. We just never addressed it before because of the stigma. Addicts are allowed to be mistreated because they are scumbags. The difference in 2017; death rates and media attention have made it harder to ignore.

Furthermore our current systemic approach is an approach that does not even touch 90% of those in need...let alone help them.

• Is this okay? Is this acceptable?
• I don't think we need more awareness. I think we need more solutions.

Thoughts:

1) Rehab is not the gatekeeper of recovery. People figure it out on their own, people find recovery in many ways. More treatment access is not the answer. You continuously hear "get them into treatment" ...as if that's a solution.

See this article on Myth of Rehab as Gatekeeper of Recovery from the Recovery Research institute.

• Can we empower rather than preach to the patient/family in need?
• Can we move our focus away from the "automatic" rehab response?
• Can providers and membership organizations please police your ranks and get rid of the marketers who spend all day everyday intimidating and bullying people into treatment centers?

2) Intensive outpatient programs (IOP) can be effective for people who are motivated and people who complete the entire program. However, some studies suggest that up to 50% drop out in first 3 months. We also know that motivation levels vary greatly. In fact, most people with an addiction issue are not motivated. Outpatient clinics could be more individualized. In the private treatment domain IOPs have been transformed into cash machines for sober living homes. These homes use IOPs to maximize reimbursement. These programs are frequently referred to as "rehabs". Most lay people do not understand the difference between an IOP and an inpatient treatment center. The Florida Model is highly problematic. IOP is especially useless for people who have been through IOP before. 9 hours a week delivered in 3 hour groups 3 times per week is not the most efficient use of time or money. The community based experience could be so much more impactful.

• Could those 9 hours of therapy be delivered in more creative ways?
• Who dictates this? Insurance? The provider?
• Why do we deliver IOP in this prescriptive way?

3) 12 step facilitation is effective for people who are willing to do 12 step programs. The studies around this type of therapy are interesting. There is clearly a benefit. However, they seem to discount the reality that 90% of the folks are completely disengaged. We base our approach on the relatively small "12 step receptive" percentage of the very small percentage (10%) that show up for treatment.

• Should we offer more alternatives?
• Should we force feed people?
• Should we wait until they hit bottom and surrender or should we explore all options?

4) Medication assisted treatment comes with all kind of baggage that is yet to be discussed in an honest manner. The stigma within the stigma. People in MAT are marginalized within recovery rooms. There is an effort for the recovery rooms to be politically correct and welcoming. However, the message is loud and clear.

From Narcotics Anonymous Information Pamphet:

Regardless of the varying experiences addicts may encounter in meetings, the fact that NA is a program of complete abstinence should not be misunderstood. 

• Can we hang our hopes on MAT without professional recovery coaching to bridge the gap?
• Shouldn't we develop a way to integrate MAT into recovery?

5) The family must be mobilized. Instead of detachment we should teach responsible influence and individualized family recovery planning.

• Can we use programs like FAVOR FAMILY RECOVERY to guide people thru a systematic response to loved one's addiction?

6) It's not about money. Money is not evil. If a program or person is actually making an impact they should be compensated. However, there are really bad providers making a massive payday.

• Is there a way to incentivize programs away from the rinse and repeat model?
• Can they be held accountable for rinse and repeat and give money back when services are proven ineffective?
• Can value based healthcare be applied to addiction treatment services?

7) Finally... can we get beyond the concept that we can only work with a willing client. The evidenced based practice of motivational interviewing and stages of change theory is promulgated throughout the entire treatment system. However, few really follow its tenets.

YOU CANNOT BE A MOTIVATIONAL INTERVIEWING PRACTITIONER AND PRESCRIBE ONLY ONE PATHWAY OF RECOVERY. ITS IMPOSSIBLE.

The vast majority of our interventions are focused on the preparation and action stages of change even though the vast majority (you could argue 90%) of those with addiction are in the pre-contemplation and contemplation stages of change. NON-SENSE.

• Can we empower and financially compensate programs that are effective in connecting to unwilling people?
• Or are we going to hold tight to the idea that a person must hit bottom? Assertive engagement strategies work.

At FAVOR Greenville we have developed a high quality professional recovery coaching organization. We are one of 9 CAPRSS accredited programs in the nation. We are a member of the association of recovery community organizations. We have served over 17,000 people and we have provided more than 40,000 hours of recovery coaching. The majority of those hours to people who do not necessarily "want" recovery. We serve the "unwilling". We are engagement experts. We believe this type of independent, autonomous organization (not affiliated with a treatment organization) is the future of professional recovery services. We know how to do this.

I'm sure there are other new solutions out there as well. Ours is just one of many new ideas. We need to champion new ideas. Adding equine therapy to your program is not innovation. I'm talking brand new ideas. Ideas that make the status quo cringe.

Tell me I'm wrong. Tell me how and where I'm off base. Let's talk about this.

Richard Jones is the President and Chief Operating Officer of FAVOR Greenville. FAVOR Greenville offers a new and innovative response to the baffling problem of addiction by focusing on assertive engagement, family empowerment and non-traditional community partnerships. WE ARE THE FUTURE. THE PARADIGM SHIFTS HERE... JOIN US.